International variation in the management of severe COVID-19 patients

Elie Azoulay; Jan de Waele; Ricard Ferrer; Thomas Staudinger; Marta Borkowska; Pedro Povoa; Katerina Iliopoulou; Antonio Artigas; Stefan J Schaller; Manu Shankar-Hari; Mariangela Pellegrini; Michael Darmon; Jozef Kesecioglu; Maurizio Cecconi

doi:10.1186/s13054-020-03194-w

International variation in the management of severe COVID-19 patients

Crit Care. 2020 Aug 5;24(1):486. doi: 10.1186/s13054-020-03194-w.

Authors

Elie Azoulay¹, Jan de Waele², Ricard Ferrer^{3

4}, Thomas Staudinger⁵, Marta Borkowska², Pedro Povoa⁶, Katerina Iliopoulou⁷, Antonio Artigas⁸, Stefan J Schaller⁹, Manu Shankar-Hari¹⁰, Mariangela Pellegrini^{11

12

13}, Michael Darmon¹⁴, Jozef Kesecioglu¹⁵, Maurizio Cecconi¹⁶

Affiliations

¹ Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France. [email protected].
² Department of Critical Care Medicine, Ghent University Hospital, 9000, Gent, Netherlands.
³ Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Instituto de Investigación de Vall d'Hebron, Barcelona, Spain.
⁴ Departmento de Medicina Intensiva, Hospital Universitario de Vall d́Hebron, Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Respiratorias, Barcelona, Spain.
⁵ Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
⁶ NOVA Medical School, CHRC, New University of Lisbon, Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, CHLO, Estrada Do Forte Do Alto Do Duque, 1449-005, Lisbon, Portugal.
⁷ Hellenic Army, ICU Nurse Manager General Military Hospital, Athens, Greece.
⁸ Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes, Barcelona, Spain.
⁹ Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care, Berlin, Germany.
¹⁰ School of Immunology and Microbial Science, Kings College London. Guy's and St Thomas' NHS Foundation Trust, ICU Support Offices, St Thomas' Hospital, London, UK.
¹¹ Department of Surgical Sciences and Central Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹² Department of Anesthesia, Operation, and Intensive Care; Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹³ Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
¹⁴ Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University, 1 avenue Claude Vellefaux, 75010, Paris, France.
¹⁵ Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁶ Humanitas Clinical and Research Center, Humanitas University, Milan, Italy.

Abstract

Background: There is little evidence to support the management of severe COVID-19 patients.

Methods: To document this variation in practices, we performed an online survey (April 30-May 25, 2020) on behalf of the European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection.

Results: A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient's management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated.

Conclusions: There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.

Keywords: Acute respiratory distress syndrome; Coronavirus; Remdesivir; Viral infection.

MeSH terms

Adult
COVID-19
Coronavirus Infections / therapy*
Critical Care*
Health Care Surveys
Humans
Internationality*
Pandemics
Pneumonia, Viral / therapy*
Practice Patterns, Physicians' / statistics & numerical data*
Severity of Illness Index